Healthcare Provider Details

I. General information

NPI: 1487980439
Provider Name (Legal Business Name): PENDLETON FAMILY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 SW NYE AVE
PENDLETON OR
97801-3833
US

IV. Provider business mailing address

2801 SW NYE AVE
PENDLETON OR
97801-3833
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-7051
  • Fax: 541-276-1020
Mailing address:
  • Phone: 541-276-7051
  • Fax: 541-276-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. LOC V VUU
Title or Position: OWNER
Credential: DDS
Phone: 541-276-7051